Case ReportHerbaspirillum Infection in Humans: A Case Report andReview of Literature

Rashmi Dhital , Anish Paudel, Nidrit Bohra, and Ann K. Shin

Reading Hospital and Medical Center, Tower Health System, West Reading, PA, USA

Correspondence should be addressed to Rashmi Dhital; rashmi046@gmail.com

Received 5 December 2019; Revised 2 February 2020; Accepted 4 February 2020; Published 20 February 2020

Academic Editor: Raul Colodner

Copyright © 2020 Rashmi Dhital et al.&is is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction. Herbaspirillum seropedicae are Gram-negative oxidase-positive nonfermenting rods of Betaproteobacteria class,commonly found in rhizosphere. More recently, some Herbaspirillium species have transitioned from environment to humanhosts, mostly as opportunistic (pathogenic) bacteria. We present a 58-year-old female with non-small-cell lung cancer (NSCLC)who presented with pneumonia and was found to have Herbaspirillum seropedicae bacteremia. Case History. A 58-year-oldwoman with NSCLC on Pralsetinib presented with fevers and rigors for 2 days. Coarse breath sounds were auscultated on the rightupper lung field. Labs revealed leukopenia andmild neutropenia. CTchest revealed right upper lobe pneumonia. She was admittedfor sepsis secondary to pneumonia and placed on broad spectrum antibiotics with intravenous piperacillin-tazobactam andvancomycin. &e patient continued to have fever 2 days after admission (max: 102.8°F). Preliminary blood cultures grew Gram-negative rods. &e patient continued to have temperature spikes on the 3rd day of antibiotics (Tmax 101.5°F). Blood culturesrevealed oxidase-positive nonfermenting rods. &e patient’s antibiotic was changed to IV meropenem on the 4th day of hos-pitalization. Ultimately, on the seventh day of hospitalization, the blood culture was confirmed from outside lab asHerbaspirillumseropedicae. &e patient started feeling better and defervesced after about 24 hours.Discussion. More recently,Herbaspirillum spp.have been recovered from humans. Our patient had Herbaspirillum bacteremia, and reported regularly cleaning her pond andweeding her garden with possible exposure to this environmental proteobacterium. Herbaspirillum may be more prevalent thanearlier thought owing to misidentification. With the institution of appropriate antimicrobial therapy, the outcomes seemmostly favorable.

1. Introduction

Herbaspirillum seropedicae are Gram-negative oxidase-positive nonfermenting rods of Betaproteobacteria class,commonly found in the rhizosphere of maize and rice,which promote plant growth via biological nitrogen fixa-tion and phytohormone production [1, 2]. More recently,some Herbaspirillium species have transitioned from en-vironment (water, contaminated soil, plant internal tissues,and root nodules) to human hosts, mostly as opportunistic(pathogenic) bacteria. Cases of human colonization andinfection have mostly been noted in cystic fibrosis andimmunocompromised cancer patients [3–8] and also insome patients without an apparent immunosuppressedstate [9–11].

1.1. Case History. A 58-year-old woman with a medicalhistory of non-small-cell lung cancer (NSCLC) with ma-lignant left pleural effusion (with RETmutation under phase1 trial with pralsetinib), nonbacterial thrombotic endo-carditis, and pulmonary embolism presented to the hospitalwith fevers, chills, and rigors for 2 days. At presentation, shewas febrile with a temperature of 101 F and tachycardic at114 beats/minute. Physical examination revealed a Port-A-catheter on the right upper chest. Coarse breath sounds wereauscultated on the right upper lung field. Labs revealedanemia with the hemoglobin level of 6.4 (ref: 12.0–16.0 g/dl),leukopenia with the white blood cell (WBC) count of 1.7 (ref4.8–10.8 10E3/ul), mild neutropenia with the absoluteneutrophil count (ANC) of 1353 cells per microliter, anelevated C-reactive protein (CRP) level of 22.52 (ref range

HindawiCase Reports in Infectious DiseasesVolume 2020, Article ID 9545243, 6 pageshttps://doi.org/10.1155/2020/9545243

<1.00) mg/dl, and an elevated creatinine level of 1.56mg/dl(baseline creatinine of 1mg/dl). CT chest revealed rightupper lobe pneumonia, scattered small pulmonary nodulesconsistent with metastatic disease, and stable bony meta-static disease of the anterior left 6th rib. She was admitted forsepsis secondary to pneumonia and placed on broad spec-trum antibiotics with intravenous piperacillin-tazobactamand vancomycin. She received 2 units of packed red celltransfusion with stable hemoglobin thereafter. Urine anal-ysis was unremarkable. Urine legionella and streptococcuspneumonia antigens were negative.

&e patient continued to have fever 2 days after admission(max: 102.8 F). Preliminary blood cultures done at our hos-pital at Day 2 of hospitalization revealed Gram-negative rods.CT abdomen and pelvis revealed small volume of ascites andjejunal wall thickening with mild adjacent mesenteric edema,suggestive of enteritis. CT chest revealed persistent rightupper lobe pneumonia. &e patient continued to have tem-perature spikes on the 3rd day of antibiotics (Tmax 101.5 F).Blood cultures revealed oxidase-positive nonfermenting rods.&e organism was not clearly identified in our lab, and thespecimen was sent to Central Pennsylvania Alliance Labo-ratory for identification by DNA sequencing using MALDI(matrix-assisted laser desorption/ionization) technique. &epatient’s antibiotic was changed to IV meropenem on the 4thday of hospitalization. Port was removed and catheter tipculture was sent, which came out to be negative.

Ultimately, on the seventh day of hospitalization, theblood culture was identified from outside lab as Herbas-pirillum seropedicae (which was susceptible to all testedantibiotics including amikacin, cefepime, ceftazidime,ciprofloxacin, aztreonam, levofloxacin, meropenem, piper-acillin/tazobactam, and ticarcillin/clavulanate). &e patientstarted feeling better and defervesced after about 24 hours ofbeing on meropenem. &e patient was discharged with amidline catheter to continue IV meropenem for a total of 14days and follow-up for outpatient monitoring. &e WBCcount at discharge was 5.1× 10 µ/L, ANC was 3978 cells/microliter, and CRP was 6.36mg/dl. On further questioningto assess for risk factors, the patient reported taking care ofher pond and regularly cleaning weeds.

2. Discussion

&e first described species of the genus Herbaspirillum wasthe bacterium Herbaspirillum seropedicae, which was foundcolonizing the roots and aerial parts of important crops [1].More recently, Herbaspirillum spp. have been recoveredfrom the blood and sputum/bronchoalveolar lavage of pa-tients with cystic fibrosis and pneumonia [4, 6, 11] and fromblood in patients with leukemia [6, 7, 12], aplastic anemia[7], multiple myeloma [13], and cellulitis [8]. Our patient is a58-year-old woman with NSCLC on RET-inhibitor pralse-tinib who presented with right upper lobe pneumonia andhad blood culture positive for oxidase-positive non-fermenting Gram-negative rod, which was confirmed asHerbaspirillium only on Day 7 of hospitalization by whichtime the patient was already improving with meropenemtherapy. On retrospect, our patient had been regularly

cleaning her pond and weeding her garden with possibleexposure to this environmental proteobacterium, support-ing this change in dynamics from environmental bacteriumto opportunistic pathogen. However, it is not entirely clearwhy the patient only defervesced and improved after 24hours of switching piperacillin/tazobactam to meropenem,even though her culture report suggested sensitivity topiperacillin/tazobactam. New genomic data findings suggestthat the transition from environmental to pathogenic led tothe loss and acquisition of specific genes to allow coloni-zation and survival in new environments. &e strains thathave been infectious to humans have lost the genes fornitrogen fixation and acquired genes for lipopolysaccharidebiosynthesis with the addition of sialic acids to evade theimmune system [1].

We reviewed the literature for available Herbaspirillumcases and identified 9 published studies from 2005 to 2019(Table 1), with Herbaspirillum bacteremia, cellulitis orpneumonia. Tan and Oehler reported Herbaspirillum bac-teremia and cellulitis in a patient with aquatic exposure [8].Ziga et al. reported Herbaspirillum bacteremia in a 2-year-old girl with a history of acute lymphoblastic leukemia (ALL)after induction chemotherapy and stem cell transplant [6].Chen et al. reported Herbaspirillum bacteremia in an ALLpatient on chemotherapy after taking sugarcane juice [12].Regunath et al. described a case of bacteremia caused bygentamicin-resistant Herbaspirillum in an immunocompe-tent adult male farmer [11]. Suwantarat et al. reported thefirst fatal case-related H. seropedicae bacteremia secondaryto pneumonia in an immunocompromised 65-year-old manwith end-stage renal disease and multiple myeloma [13].Abreu-Di Berardino et al. described Herbaspirillum hut-tiense pneumonia in a patient with essential thrombocytosis[9]. Liu et al. reported Herbaspirillum huttiense bacteremiain an elderly patient with no obvious immune suppression,who later went on to develop a pneumonia, where despiteadequate treatment, microbiological eradication was noteasily achieved, and septicemia lasted for several days alongwith sputum culture positivity forHerbaspirillum huttiense 2months later [10].

Chemaly et al. investigated a potential cluster of hospital-based Herbaspirillum infections in cancer patients at theUniversity of Texas MD Anderson Cancer Center, initiallyidentified as Burkholderia cepacia complex and subsequentlyreidentified as Herbaspirillum species by the Cystic FibrosisFoundation Burkholderia cepacia Research Laboratory andRepository (BcRLR) at the University of Michigan. &eauthors identified a total of 8 patients with bacteremia andpneumonia with cultures positive for Herbaspirillum speciesbetween July 2011 and August 2012 (including 5 clusters and3 additional cases identified prospectively). 5 of the 8 pa-tients were females and the median age was 53 years (2–67years) [7].

Spilker et al. reported a 26-year-old male with moderateto severe lung disease with Gram-negative rod bacteremia athospital day 23. &e patient was admitted for methicillin-resistant staphylococcus aureus (MRSA) and Pseudomonaspneumonia, and cultures were initially misidentified asBurkholderia cepacia complex [4]. &e authors analyzed

2 Case Reports in Infectious Diseases

Tabl

e1:

Summarytableof

publish

edcasesof

Herbaspirillu

minfectionin

humans.

Autho

ryear,

coun

try

Age/

sex

Past

history/

predisp

osing

cond

ition

s/cancer/

HCST

Immun

esupp

ression

Likely

risk

factor/in

citin

gevent

Reason

for

admiss

ion/Clin

ical

presentatio

nInitial

antib

iotics

Respon

seto

initial

antib

iotics/

subsequent

antib

iotics

Specim

ensource

positivefor

Herbaspirillu

m

Liu2019,K

orea

93/F

Hypertension

Advancedage

N/A

—

(i)Fever,seizure

(ii)A

ftera

fewdays,

hypo

xiaandchest

X-ray

with

pneumon

ia

Empiric

vancom

ycin+ceftriaxone

for

enceph

alitis

Chang

edto

merop

enem

and

colistin

at10

days

and

changedto

cefta

zidime,

minocyclin

e,and

trim

etho

prim

/sulfametho

xazole

thereafte

r

Bloo

d:Herbaspirillu

mhu

ttiense

2mon

thslater,

sputum

:Herbaspirillu

mhu

ttiense

Abreu-di

berardino2019,

Spain

59/F

Aortic

wall

thrombo

sis,v

isceral

andcerebral

ischemic

lesio

ns,

JAK2+essential

thrombo

cytopenia,

new

DM

N/A

—

(i)Generalized

decond

ition

ing

(ii)D

yspn

ea10

days

afteradmiss

ion,

nosocomial

pneumon

ia

Piperacillin-tazobactam

Recoveredcompletely

afterantib

iotics

Sputum

:Herbaspirillu

mhu

ttiense

Chen2010,C

hina

48/F

Acute

lymph

oblastic

leuk

emia

On

chem

otherapy

andG-C

SF

Drank

sugarcanejuice

before

fever

started

Fever,chills

Cefmetazoleandgatifl

oxacin

Improved

Bloo

d:Herbaspirillu

mhu

ttiense

Spilk

er2008,U

SA26/

m

Mod

erateto

severe

lung

disease,

pancreatic

insufficiency,

diabetes,a

ndliver

disease

Recent

multip

leadmiss

ions

for

exacerbatio

nof

respiratory

symptom

s

—

Fevers

andrigors,

MRS

A,and

Pseudomon

asaerugino

sabacterem

ia

Vancomycin,p

iperacillin-

tazobactam

,and

tobram

yicn

x20

days

Antibiotic

discon

tinuedat20

days,afte

rFE

V1startedto

improve

Ontheho

spita

lday

23:fever

andrigors

Chang

edto

intravenou

scefta

zidimeand

tobram

ycin

andoral

trim

etho

prim

-sulfametho

xazole

(TMP-SM

X),

levoflo

xacin,

and

minocyclin

e

Bloo

d:(G

NR,

initially

identifi

edas

burkholderia

cepacia

complex)Later,

identifi

edas

Herbaspirillu

mspecies

Case Reports in Infectious Diseases 3

Tabl

e1:

Con

tinued.

Autho

ryear,

coun

try

Age/

sex

Past

history/

predisp

osing

cond

ition

s/cancer/

HCST

Immun

esupp

ression

Likely

risk

factor/in

citin

gevent

Reason

for

admiss

ion/Clin

ical

presentatio

nInitial

antib

iotics

Respon

seto

initial

antib

iotics/

subsequent

antib

iotics

Specim

ensource

positivefor

Herbaspirillu

m

Tan2005,U

SA49/

mProb

able

hepatic

cirrho

sis—

Hom

eless

Jumpedfrom

abridge

into

afreshw

ater

canalincentral

Florida

Increasin

gerythemaand

warmth

totheleft

leg(cellulitis)

Ampicillin/sulbactam

Antibioticssw

itched

tocefepimeand

levoflo

xacinafter

initial

bloo

dcultu

reresults

Bloo

d:(oxidase-

positiveno

nlactose-

ferm

entin

gGNR,subm

itted

toan

outsidereference

labo

ratory)po

sitive

forHerbaspirillu

mseropedicae

Regunath

2014,

USA

46/

M

Childho

odasthma,

atypicalpn

eumon

iaas

ateenager,

tonsillectomy

N/A

Farm

ingin

ruralM

issou

ri,

closecontact

with

cattleand

turkeys,mold

andpo

ssible

rat

excreta

Drenchedin

rain

during

afishing

trip

Fever,fatig

ue,S

OB,

nigh

tsweats,

anorexia,m

yalgia,

andheadache

Dry

cough,

righ

t-sid

edpleuritic

chestp

ain,

andworsening

dyspneaHypoxia

(multilob

arpn

eumon

ia)

Vancomycin,ceftriaxone,

andazith

romycin

Ceftriaxone

switched

topiperacillin-

tazobactam

Azithromycin

switchedto

Doxycyclin

eAfte

r12

days

oftreatm

ent,thepatient

improved

andwas

extubated

Bloo

d(D

ay1)

(from

referringfacility)

identifi

edas

Burkholderia

cepacia

complex

(BCC),later

asHerbaspirillu

maqua

ticum

orHerbaspirillu

mhu

ttiense

BAL(D

ay3):G

NRas

Herbaspirillu

maqua

ticum

orHerbaspirillu

mhu

ttiense

Chemaly2015,

USA

Hospital-b

ased

clusterof

Herbaspirillium

spinfections

initially

misidentified

asB.

cepacia

48/F

Ovarian

adenocarcino

ma

Chemotherapy

Source

and

mechanism

ofthecluster

unkn

own

Pseudo

mon

asBS

I,sepsis-CRB

SI

Cefepim

e(5

patients),

cefta

zidime(1

patient),

moxifloxacin

(1patient),

merop

enem

(1patient)

initially

Follo

wed

byceftriaxone

orflu

oroq

uino

lone

Allpatientsim

proved

with

antib

iotic

and

hadnegativ

erepeat

bloo

dcultu

res

1patient

had

recurrence,w

hich

resolved

once

thepo

rtwas

removed

Bloo

d,Infusapo

rttip

67/F

Leuk

emia

Chemotherapy

MRS

Apn

eumon

ia,

sepsis-BS

IBloo

d

58/

MLeuk

emia/H

SCT

High-do

sesteroid

GIbleedGVHD,

BSI

Bloo

d

55/F

Leuk

emia/H

SCT

High-do

sesteroid

GIGVHD,B

SIBloo

d

2/M

Ependymom

aHigh-do

sesteroid

Herbaspirillium

Sepsis-BS

IBloo

d

4 Case Reports in Infectious Diseases

Tabl

e1:

Con

tinued.

Autho

ryear,

coun

try

Age/

sex

Past

history/

predisp

osing

cond

ition

s/cancer/

HCST

Immun

esupp

ression

Likely

risk

factor/in

citin

gevent

Reason

for

admiss

ion/Clin

ical

presentatio

nInitial

antib

iotics

Respon

seto

initial

antib

iotics/

subsequent

antib

iotics

Specim

ensource

positivefor

Herbaspirillu

m

3additio

nal

Herbaspirillium

spaftercontinued

surveillance

(sporadic)

66/F

Historyof

recurrent

pneumon

ia,lun

gcancer

Radiation

therapy

Herbaspirillium

Sepsis-pn

eumon

iaSputum

18/

MLymph

oma

Chemotherapy

Chemotherapy

Sepsis-BS

IBloo

d

51/F

Aplastic

anem

ia/

HSC

TTacrolim

usHerbaspirillium

Sepsis-

CRB

SIBloo

d,PICClin

etip

Suwantarat2015,

USA

65/

M

Multip

lemyeloma

ESRD

onhemod

ialysis

Steroids

and

lenalid

omide

Acute

respiratory

failu

reandseptic

shockRigh

tlow

erlobe

pneumon

ia

Vancomycin,cefepim

e,ciprofl

oxacin,and

micafun

gin

Chang

edto

vancom

ycin,

merop

enem

,and

gentam

icin

with

in12

hoursHow

ever,the

patient

remained

clinicallyun

stableand

died

after4days

BAL(oxidase-

positive,no

nlactose-

ferm

entin

gGNR),

initially

identifi

edas

Cupriavidu

s,lateras

Herbaspirillu

mBloo

d:Herbaspirillu

mseropedicae

Ziga

2010,U

SA2/F

Acute

lymph

oblastic

leuk

emia

Chemotherapy,

HSC

T

Uncertain

Lives

with

herp

arents

and

grandp

arents

onalargefarm

Feveranddiarrhea

Cefepim

e

Gentamicin

added

afteroxidase-po

sitive,

weaklycatalase-

positive,Gram-

negativ

ebacillu

sLater,sw

itchedto

merop

enem

Bloo

dBu

rkholderia

cepaciacomplex

As

susceptib

ilitypatte

rnwas

notc

onsis

tent,

furtheridentificatio

nwas

pursued:

Herbaspirillu

msp

G-C

SF:g

ranu

locyte-colon

ystim

ulatingfactor;B

AL:

bron

choalveolarlavage;G

IGVHD:g

astrointestin

algraftv

ersusho

stdisease;BS

I:bloo

dstream

infection;

CRB

SI:catheter-relatedbloo

dstream

infection;

HSC

T:hematop

oietic

stem

cellinfection;

GNR:

gram

-negativerod.

Case Reports in Infectious Diseases 5

isolates from sputum from over 1,100 cystic fibrosis patientsacross 8 years (January 2000 to December 2007) and foundHerbaspirillum in only 28 patients (<3%) with ages rangingfrom 20 months to 5 years, of which 3 isolates were Her-baspirillum huttiense, 3 were Herbaspirillum frisingense, 2were Herbaspirillum seropedicae, and 2 were Herbaspirillumputei, and the remaining eighteen isolates could not bespeciated [4]. Prior to the correct identification of Herbas-pirillum at the BcRLR for the above 28 specimen, they hadbeen identified as Burkholderia cepacia complex in 19 (68%)and Ralstonia in 4 (14%).Most patients appeared to have hadtransient respiratory tract colonization with Herbaspirillumexcept for bacteremia in one patient and a chronic respi-ratory tract infection in another [4].

Tetz and Tetz, for the first time, identifiedHerbaspirillumfrisingense from the bladder of a human patient with urinarytract infection (UTI). Furthermore, genome analysisrevealed numerous factors such as adhesins, urease, he-molysin D, and pilin that contribute to the bacterium’svirulence in UTIs. &e authors suggested that further re-search of this Herbaspirillum spp would aid in better un-derstanding of its implication in UTI [14]. Similarly, Wuet al. performed a comprehensive analysis of urinary mi-croenvironment of bladder cancer and identified Herbas-pirillum as one of the species associated with an increasedrisk of progression, suggesting its potential role in riskstratifying bladder cancer [15].

As evidenced by the above studies, Herbaspirillum is anemerging pathogen and may be more prevalent than earlierthought owing to misidentification for organisms likeBurkholderia cepacia complex due to phylogenetic andphenotypic resemblance [4, 6, 7, 13]. Antimicrobial sus-ceptibilities may serve as a means for differentiating Her-baspirillum species from Burkholderia cepacia complexbecause the latter are usually multidrug resistant, whereasHerbaspirillum is not. With the institution of appropriateantimicrobial therapy, the outcomes seem mostly favorableand the bacteria appear to be easily eradicated, except in 1case reported by Liu et al. Misidentification as Burkholderiacomplex can have serious implications for clinical care, anddistinction between these is important due to different re-sistance profiles and different therapeutic implications. &eincreased availability of newer molecular methods (e.g.,MALDI-TOF MS) should allow laboratories to correctlyidentify this organism and reduce misidentification byestablished microbial identification systems.

Conflicts of Interest

&e authors declare that they have no conflicts of interest.

References

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[2] A. C. Q. Marques, K. S. Paludo, C. B. Dallagassa et al.,“Biochemical characteristics, adhesion, and cytotoxicity of

environmental and clinical isolates of Herbaspirillum spp.,”Journal of Clinical Microbiology, vol. 53, no. 1, pp. 302–308,2015.

[3] T. Coenye, J. Goris, T. Spilker, P. Vandamme, andJ. J. LiPuma, “Characterization of unusual bacteria isolatedfrom respiratory secretions of cystic fibrosis patients anddescription of Inquilinus limosus gen. Nov., sp. Nov,” Journalof Clinical Microbiology, vol. 40, no. 6, pp. 2062–2069, 2002.

[4] T. Spilker, A. Z. Uluer, F. M. Marty et al., “Recovery ofHerbaspirillum species from persons with cystic fibrosis,”Journal of Clinical Microbiology, vol. 46, no. 8, pp. 2774–2777,2008.

[5] W. Chen, Y.-Y. Chen, C.-F Tsai et al., “Incidence and out-comes of acute respiratory distress syndrome,” Medicine,vol. 94, no. 43, p. e1849, 2015.

[6] E. D. Ziga, T. Druley, and C.-A. D. Burnham, “Herbaspirillumspecies bacteremia in a pediatric oncology patient,” Journal ofClinical Microbiology, vol. 48, no. 11, pp. 4320-4321, 2010.

[7] R. F. Chemaly, R. Dantes, D. P. Shah et al., “Cluster andsporadic cases of Herbaspirillum species infections in patientswith cancer,” Clinical Infectious Diseases, vol. 60, no. 1,pp. 48–54, 2015.

[8] M. J. Tan and R. L. Oehler, “Lower extremity cellulitis andbacteremia with Herbaspirillum seropedicae associated withaquatic exposure in a patient with cirrhosis,” Infectious Dis-eases in Clinical Practice, vol. 13, no. 5, pp. 277–279, 2005.

[9] M. Abreu-Di Berardino, E. Rodrıguez-Czaplicki, andV. Sanchez-Hellın, “Herbaspirillum huttiense pneumonia in apatient with essential thrombocythaemia,” Revista EspanolaDe Quimioterapia: Publicacion Oficial de la Sociedad Espanolade Quimioterapia, vol. 32, no. 1, pp. 83-84, 2019.

[10] C. Liu, M. J. Kwon, M. Kim, J.-H. Byun, D. Yong, and K. Lee,“Septicemia caused by Herbaspirillum huttiense secondary topneumonia,” Annals of Laboratory Medicine, vol. 39, no. 3,pp. 340–342, 2019.

[11] H. Regunath, J. Kimball, L. P. Smith, and W. Salzer, “Severecommunity-acquired pneumonia with bacteremia caused byHerbaspirillum aquaticum or Herbaspirillum huttiense in animmune-competent adult,” Journal of Clinical Microbiology,vol. 53, no. 9, pp. 3086–3088, 2015.

[12] J. Chen, Z. Su, Y. Liu et al., “Herbaspirillum species: a potentialpathogenic bacteria isolated from acute lymphoblastic leu-kemia patient,” Current Microbiology, vol. 62, no. 1,pp. 331–333, 2011.

[13] N. Suwantarat, L. T. L. Adams, M. Romagnoli, andK. C. Carroll, “Fatal case of Herbaspirillum seropedicae bac-teremia secondary to pneumonia in an end-stage renal diseasepatient with multiple myeloma,” Diagnostic Microbiology andInfectious Disease, vol. 82, no. 4, pp. 331–333, 2015.

[14] V. Tetz and G. Tetz, “Draft genome sequence of the uropa-thogenic Herbaspirillum frisingense strain ureolyticus VT-16-41,” Genome Announcements, vol. 5, no. 17, pp. e00279–17,2017.

[15] P. Wu, G. Zhang, J. Zhao et al., “Profiling the urinarymicrobiota in male patients with bladder cancer in China,”Frontiers in Cellular and Infection Microbiology, vol. 8, p. 167,2018.

6 Case Reports in Infectious Diseases